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09 August 2010

Mental Health

By the time I left Hooper, the in-patient facility, it was ten years after I'd started. I was so nervous getting there the first time, I was exploding in the little Toyota truck on the way in. I didn't know at the time, I was meeting myself in the work there.

By the time I left, my boss (Ed Blackburn) estimated I'd interacted with over 50,000 patients. Acupuncture is based on experience. Those interactions left me a changed man.

The type of patients I'd feared the most I wrote about in the last blog.

The patients who taught me the most were the ones with 'mental health issues,' as we say in our culture.

In our field, we sometimes half-joked about taking a 'mental health day' -- a day off to recoup. We all needed them.

What was stressful about our job?
There was no heavy lifting....
It was a matter of the heart.
Most days, something would break it.

When I started doing acupuncture at Hooper, my heart was weary to see some patients hiding under their beds when it was time for acupuncture. Or in the shower --fully clothed.

"Come out and let's talk about it," I'd say.

All of the patients who hid themselves away during acupuncture had a severe mental health issue.
If you've met someone like that, you know how gentle they are. Our treatments were doing just one thing: blowing them away. They couldn't handle it.

I listened and negotiated with them. I told them to take a break, and then when they were ready, we could try just a few needles.

I went home and looked up more treatment ideas for what they had. The Chinese sources had what we needed. There were protocols for hallucinations, anxiety, 'yang psychosis' (throwing chairs), anger issues --there was plenty to try.

One man who had a particularly hard time with needles was amenable to trying moxa, a heat treatment. We use a compressed herb, mugwort, a relative of sage, formed into something like a huge incense stick that is held over acupoints. A Chinese text recommended moxa on a Small Intestine channel point on the neck (SI 17) for auditory hallucinations. When we did that, he could feel a circle going from his neck to his brain. The voices stopped. It all tickled him.

I learned and tried a lot on these patients. I found I was able to get very good results with psychiatric conditions. This was an area we never studied in school. I often had to wing it. Just finding good protocols was not enough. I found I had a resonance with the psych patients, an understanding. I was puzzled by it.

We were then asked to do acupuncture at a community mental health clinic in on Northeast Alberta street in Portland. To be in a room filled with people with mental health diagnoses, on medications for severe mental health issues --and do acupuncture on them was new. I worked in psychiatric settings: It was my first job after college, a burnout path. But to be their acupuncturist led to a different level of interaction. I was scared, but had no choice but to plunge in.

In feeling into them, I realized that I held a love for these patients that I had for my grandmother. My mother's mother suffered from bouts of psychosis. It was brought out when her husband left for both world wars. Running a farm with five children was a stressor. She was beautiful, a poet, dignified and very quiet.

From that connection, I felt I knew what to do with these patients. That proved essential, since conventional protocols didn't always work. One point listed in contemporary texts for auditory hallucinations (San Jiao 17) seemed like it ought to work--but never did.
Instead, one day while treating a patient with voices, I got an idea to use a set of three points on the back of the neck. After they worked, I looked them up. One was called Ya Men in Chinese, which may translate to Muteness Door. Acupuncture is bi-directional: this is a well-known point for treating deaf-mutism, but it was the first I'd known of it for silencing an irritating inner voice. The points below it, to my surprise, were called Fu YaMen, or Below Mute Door. From their names, they were meant to go with together, and formed a triangle about an inch apart, with YaMen at the apex.

More commonly, I used a Scalp Acupuncture point for disturbing voices on the auditory center of the brain, just above the tip of the ears (GB 8 & 9). This worked in about 5 minutes, and on every patient. There was not a single time it did not work; I used it hundreds of times. Just this year, I found that ancient Chinese understanding of the brain understood the use of this point to affect the ear in this way.

At the time I was making these discoveries, or re-discoveries, an Aleut medicine woman taught me something. Her name was Share Bear, and she came to Hooper to teach. She came in her traditional apparel from the Aleutian Islands, head held high and carrying a huge walking stick. As we were crossing Martin Luther King Drive, she said, "The real problem, Roger, isn't when people hear voices: It's when they don't hear them at all." Good point!

Whatever happened to that inner voice we once knew and loved?
In contemporary culture, the inner voice was relegated to irrelevance, insanity and untruth in the quest for objectivity. That gave us a certain knowledge, but physicists now tell us there is no such thing as objectivity.

The Chinese classics never saw a problem with subjectivity. They excelled in building an organized, inter-subjective field. As Wilber points out (see previous blog), this is not 'merely subjective,' but the basis of culture and language.

The acupuncture classics provided an architecture of the soul, poetic writing that was not taken up by later herb classics.

My training in acupuncture emphasized treating the Liver channel, as is common in contemporary Chinese texts and clinics. I was puzzled that so much was going on in the Heart instead --until I read the Chinese classics years later.

Mental-emotional issues are disparaged in our culture. Just the terms are enough to make us run away. For example, when someone is 'mental,' that is a demeaning term. "You're so emotional" is another pejorative remark. Psych and psycho translate as 'whack job.' Not good.

If we are to heal the psyche in our culture and times, we will need to upgrade the language. Chinese is a better place to start. The term for the mental-emotional aspect is called the Jing-Shen, or Essence-Spirit.

It's not just a spiritual thing: that has connotations that can be airy-fairy or highly debatable in our culture. When we first call it Essential, of the Essence as half of it, then we have something real, something substantial and important. Essence-Spirit is a perfect term for what is considered the most refined part of the life of our organs.

To call someone depressed or psychotic isn't real in a scientific sense: there is not objective validation of that reality, unlike diabetes, for example. There are intriguing patterns, but no definitive diagnosis. Psychiatry a matter of convention, of collective subjective definitions and agreements. This does not make mental health issues less real or significant. It can make them our collective responsibility. The Chinese experience in crafting a collective-subjective medicine can teach us how to go about it.

Every day, I am proud to ride my bike to work. More importantly, I love the exhilaration it provides. For a year now, I ride past people laying on the sidewalk, sleeping into the morning by the river or on the bridge. In my car, I could remove myself from them and turn up the radio. On a bike, rain or shine, I'm just feet away from their feet. Jungians say the homeless are manifestations of my psyche, as is everything. They got that idea from the Buddhists. So, there is part of me: laying on concrete at ten in the morning, face pressed under the metal railing to get as close to the river as possible. Even downtown, there is peace and solace in that river.

They cleared out the mental health hospitals while I worked at Hooper. A yellow schoolbus, rented by the state, would pull up across the street from the homeless shelter on our block called Baloney Joe's. The doors opened up to freedom, cascading patients who'd not been out of an institution for 20 or so years. "Here's your new home," they were told.

Homeless activists made them stop that madness. A more subtle route was found for discharging patients during those rounds of cutbacks. Our neighborhood became a psych ward.

My grandmother's spirit is probably still out there somewhere.

I found my maternal grandmother's Essence-Spirit in those acupuncture clinics. She taught me that there is a lot that we can do for more sane, loving and humane care of the lost among us. The methods in Chinese medicine are simple, effective, safe and teachable. They are needed.